Dialysis and Travel support pages - Dialysis Konnections and our Australian Dialysis Unit Guide

If on dialysis and thinking of travel
First ask your health care team how travel may affect your health. If well enough, with careful planning, a holiday can boost your confidence and well being.

However, when you live with chronic disease there are major road blocks to negotiate before you can travel sensibly.

The most obvious - significant funds to cover costs for any health emergency, plus treatment and medicine costs. If on dialysis, treatment can be expensive!

Capacity pressure - Dialysis Units
With increasing demand for dialysis in Australia and globally - dialysis sessions and travel should be booked well in advance. Dialysis Units support kidney patients wanting to travel where possible, but often don't have spare sessions. Check our Australian Dialysis Units Guide to contact a Dialysis Unit. 

Links below offer holiday dialysis suggestions, both Australian and international.

FOR NSW RESIDENTS ONLY: Away From Home Haemodialysis Program 
Service for haemodialysis patients living in NSW, offers patients better access to haemodialysis services when travelling away from home for education, work and holidays. Eligible patients may access up to 3 sessions a year at one of 25 participating private renal units at no cost. Subject to availability and program funding - Patient Fact Sheet.

Australian Dialysis Konnections Register - Dialysis Chair Exchange Program
Australian dialysers who wish to travel in Australia can use this program to connect with other Aussie dialysers privately, to arrange a 'dialysis chair swap'. Your renal unit staff must agree to this swap. Steps required to 'connect' are simple and easy to follow. Go to our ADKR webpage for  info.

Booking travel dialysis arrangements in Australia 
Do not do try to organise dialysis without talking with your health team! When arrangements are made, confirm dialysis session times in advance - you must be flexible with plans.

Private dialysis in Australia may offer temporary dialysis but charge a fee for each treatment
As a guide, the approximate cost is between $450 to $650 per treatment in Sth Australia. In eastern states between $800 to $900 per treatment, depending on location. Ensure you book in advance, receive a firm quote and confirmation of treatment dates. Minimum 1 month notice required.

Medically required medications
Work out expected medical costs before making travel plans including medications you will need. Note many countries including Australia only allow you to bring medically required medications to cover you for a maximum of 3 months (at maximum dosage).

A personal treatment letter is essential
Anyone with a chronic condition should take a current treatment letter from your usual doctor, to present to Customs Officers. Be careful to check drugs considered illegal in countries you may travel in, especially pain killers or if opiates are used. Erythropoietin is banned for sports persons - so ensure if you need this drug, it is included in your treatment letter - otherwise you may be fined, face lengthy delays in Customs, or worse. Refer Prohibited list; Therapeutic use exemptions World Anti-Doping Agency.

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MEDICALLY NECESSARY TREATMENT UNDER RECIPROCAL HEALTH CARE AGREEMENTS  

The Australian Government has Reciprocal Health Care Agreements (RHCA) with several countries. However, each agreement is different and varies in benefits, for medically necessary treatmentn for duration and eligibility. 

This is a very complex area of travel health cover especially if you have multiple chronic health conditions.

Not all treatment is covered under an RHCA
Exceptions are: pre-arranged or elective treatment not immediately necessary, ambulance cover and para medical services, dental care, medical evacuation to your home country, funerals, treatment in private hospitals, or as a private patient in a public hospital.

Medicare Australia - Call 132 011 to locate a Medicare office
TTY 1800 552 152 for hearing/speech impaired - 131 450 for interpreting service

• Medicare - Australians travelling overseas and Medicare - Visitors to Australia
• Private Health An Australian Government resource 1300 737299 (local call) 9am-5pm M-F (EST)
• Private Health Insurance Ombudsman 1800 640 695
• Australia's Reciprocal Health Agreements - Health Insurance Consultants (HIC) Australia
• Overseas Skilled Workers: health requirements - Australian Immigration Fact Sheet 22
  Considering skilled work in Australia - both you or family must be healthy. Check strict health criteria needed to gain this Australian Temporary Visa for every family member

Countries under Australian RHCAs which cover medically necessary treatment INCLUDING dialysis:
Netherlands - New Zealand - United Kingdom may provide access to dialysis for Australians as RHCA eligible visitors, but there are limits.

Australians overseas - entitlements for treatment under an RHCA (Click link)
To receive medically necessary treatment for any ill-health or injury whilst visiting an RHCA country, you should provide local health authorities with:

• Australian passport or other passport which shows you are a permanent Australian resident
• valid Medicare card - check date to ensure you will be covered until you return to Australia
• if known treatment is expected, advise medical staff you wish to be treated under an RHCA with Australia, to establish dialysis capacity. Be aware co-payments apply - there are limits .

Visitors to Australia - entitlements for treatment under an RHCA (Click link)
As a resident of an overseas RHCA country you are entitled to the following for medically necessary treatment for any ill-health or injury whilst in Australia. This does not include treatment considered ongoing, or elective and does not cover treatment in a private hospital. You are entitled to:

• free treatment as a public in-patient or outpatient in a public hospital
• subsidised medicines under the Pharmaceutical Benefits Scheme (PBS)
• Medicare benefits for out-of-hospital medical treatment provided by doctors through private surgeries and community health centres

RHCA eligible visitors to Australia are entitled to use dialysis services in Australia as a public patient
The number of dialysis treatments a person receives depends on availability of resources of the treating hospital. Australia has agreed to provide RHCA visitors with free dialysis services for the lesser of either a maximum period of four weeks (covering all service sites) or a maximum of 12 sessions within a 12 month period, commencing from the date of first treatment.

Dialysis in Medicare funded dialysis units for eligible patients is based on clinical need
The ability of the Australian health system to fund eligible overseas patients must not interfere with the physical, clinical and/or financial capacity of the relevant Area Health Service to meet clinical priorities of Australian residents. In reality you may have difficulty in finding spare capacity in public Australian Dialysis Units.

Australian capacity guidelines
Dialysis is limited to one RHCA patient at each site, subject to availability of staffing and resources. No eligible Australian patient will be disadvantaged due to this decision. Each Australian state may impose limits on number of free treatments offered and it varies.

Most temporary visitors to Australia are not covered under an RHCA
Overseas visitors on temporary visas are not eligible for Australian Medicare benefits, unless they are from a country with which Australia has a 'Reciprocal Health Care Agreement'. Australian Medicare benefits are not an option for general care. It is strongly recommended all travellers with a chronic disease try to acquire some level of travel and private health insurance. If no cover is possible, ensure sufficient funds are available to cover emergencies, medications and treatment

If travelling on a Student Visa in any RHCA country you must take out Overseas Student Health Cover, so be sure to confirm that should you need dialysis, or treatment if transplanted, you will be covered.

Visitors from New Zealand and Republic of Ireland should present their passport to Australian hospital clerical staff to be eligible for cover under Medicare. Access to public health care in Australia for visitors under an RHCA is restricted to a person ordinarily resident in the Republic of Ireland and temporarily in Australia. Such visitors will not be issued with Medicare cards.

Visitors from Finland - Norway - Sweden must take your passport and travel visa to a Medicare office to be registered and be given a Medicare number. This card and number must be presented to hospital clerical staff to prove eligibility to Medicare. Registration may be done during or after your hospital stay. If you do not register you may be liable for the costs of treatment.

Visitors from Belgium - Slovenia - Netherlands - present your current European Health Card and passport. Residents of Malta and Italy - are only covered for six months from date of arrival.

Countries offering RHCA cover via Medicare for medically necessary treatment but NOT dialysis:
Belgium - Finland - Italy - Malta - Norway - Republic of Ireland - Slovenia - Sweden

In Australia and overseas be aware delays can be expected if a bed in a public hospital isn’t available. Even if eligible for free treatment, you may prefer to have control over when and where you’re treated, and by whom, via private travel health cover.

TRAVEL HEALTH INSURANCE
WHEN YOU HAVE KIDNEY DISEASE

When you have any chronic disease you should be realistic about the likelihood of getting travel insurance for a pre-existing condition. For Aussies needing a break from routine - consider locations in Australia, to other city centres perhaps, as a better option to overseas, remote or long distance destinations. Don’t book any travel arrangements until you are sure you will be covered by travel health insurance for pre-existing medical conditions and budget for any emergency.

Will you qualify for travel health insurance?
If you had private health insurance cover when you developed a chronic condition, you may be able to obtain travel cover from your usual health insurance company. If you had a complex path to kidney failure, are experiencing dialysis issues, or have multiple health conditions, you may not find a travel insurer.

As a guide: Travel insurance may be granted if you have kidney disease, have had a transplant at least six months old; there must never have been a rejection or infection and your overall health must be stable. Travel insurance will not usually cover anyone on a transplant waiting list or with a complex health history. 

Travel insurance for pre-existing kidney disease varies
Agencies display policies on websites but  these can be difficult to understand - contact an insurance broker.

Consider basic travel insurance to cover emergencies. Pay for your travel with a credit card which offers travel insurance. Consider basic travel insurance via a union, bank or even Superannuation. 

Ask specific questions about any cover you consider, especially if you have one or multiple pre-existing health conditions. Some cover may be offered but will exclude existing chronic conditions. Some level of travel insurance is still strongly advised.

TIPS FOR OVERSEAS TRAVEL WITH KIDNEY DISEASE

Obtaining haemodialysis in other countries is possible - be aware standards of care may differ to Australian standards, each country is different. Some global holiday dialysis centres specialise in this field and a quality service is guaranteed - but charge for their services. See some travel destinations to consider from weblinks below but enquire about their standards and care and what is covered for your fee.

Travel on Peritoneal Dialysis (PD) is simpler - but requires careful planning. Dialysis supplies in most cases can be delivered to your destination. Make arrangements for delivery of your dialysis supplies in advance. Ask your health team if they can arrange contacts for back-up medical care, essential in case of ill health.

This article may offer 'food for thought' Peritoneal Dialysis Travel 'Tool Box'
Nephrology Nursing Journal Sept-Oct 04. Bobbie Knotek, Laurie Biel USA

Travel when waiting for a Kidney Transplant - consult your doctor and Transplant Coordinator to decide if you will be able to return in time, if a kidney becomes available. You are unlikely to receive travel insurance whilst on the transplant waiting list, or for up to two years post transplant, and your health must be seen as stable.

TRAVEL ADVICE IF YOU TRAVEL AND HAVE KIDNEY DISEASE
Medical and treatment advice

• Our Australian Dialysis Unit Guide (DUG online) helps locate Australian Dialysis Units.
  
• Ensure your unit staff confirm dialysis arrangements a few weeks before you travel as capacity can change, especially in a public unit. Refer to: Travel & dialysis: How can nurses help? Educational Supplement Ren Soc Aust J 5(3) 152-154 Black, K (2009)
  
• Transfer forms providing personal treatment references (ask at your unit) will be sent in advance to your destination unit. Carry copies of this paperwork with you at all times. If travelling in an emergency, dialysis details can be forwarded by your unit to the Dialysis Unit which accepts your request.
  
• When on holiday your health care team must be able to contact you, especially if on the transplant waiting list. Ensure the health team have your detailed travel itinerary with contact information. Advise dialysis unit staff of any changes you make to your travel itinerary or plans.
  
• Be aware, pre-holiday blood tests are compulsory for most units at home or overseas - allow enough time to have these tests done and to receive results. Check if vaccines are needed in countries where you are travelling - some vaccines are not recommended for dialysis patients. Transplant patients have to be especially careful of vaccines.
  
• Keep an up to date treatment letter from your doctor with you at all times (keep a copy on your person and one in checked luggage) summarising your health, results of recent lab results and medications you take, and why. You may need to provide this for Customs and essential information if you need to consult a doctor away from home. Keep a scanned copy of this letter attached to an email for emergencies. Keep your treatment letter in a safe place in case until it is needed. Your doctor can provide a copy, but this is not ideal if you need urgent treatment or medications.
  
• Take enough medication for the whole trip with some extra in case of lost luggage or spillage. (Note max 3 month supply allowance limit). You may arrange for supplies to be delivered ahead of time to destinations. If pre-ordering ensure supplies arrive at your destination before departure. Ask your doctor if you may need a different type of drug or prescription in other countries.
  
• Travel with at least a 3 day reserve of supplies in case of unexpected travel delays - weather, flight delays, unexpected scheduling problems or shipment delays. Bags can go astray, they may arrive on the next flight, but to be safe always pack all medications in carry-on bag, never in checked luggage.
  
• Planes don't have fridges for personal use - if you have a drug which must be kept cool ask your pharmacist how to pack it for travel. Check if your hotel has a fridge as some do not - they may suggest options. Consider packing medications in a thermo-bag with re-usable freezer packs. A wide-necked thermos chilled in advance also works. Make sure you allow time for transfers and delays when calculating the length of a trip when medication may be unrefrigerated.
  
• Ensure you arrange in advance, a clean space to do exchanges and store supplies. Carry 2 universal connectors, one in personal bags and one in checked luggage, in case one is lost in transit.
  
• If you bring syringes you must bring the drug you inject, like insulin etc (some countries including Australia require a special license for certain drugs). Any drug you carry must have a professionally printed label that clearly identifies it. There is no limit to how many empty syringes you can take as long as you also have the drug with you. On your return trip make sure you declare any drugs you were given or prescribed. A treatment letter may also be requested by Customs when returning home.
  
• If you travel by plane or train, make arrangements for special meals (e.g. low-salt, low-fat or diabetic) when you book in advance. If diabetic, carry glucose tablets and snacks such as low-potassium juice to treat low blood sugar. Travel with lunch or nutritional supplement in case of delays. Managing your diabetes can be simpler by having insulin, syringes and blood glucose monitoring in hand luggage.
  
• Take emergency supply of bandages, pain killers, insect-bite ointment and anti-diarrhoea pills. Check with your health team regarding over-the-counter drugs you may use. Avoid over-exposure to the sun - take a high-factor sunscreen and use it - sun protection is very important for transplant patients.

TRAVEL WITH A CHRONIC DISEASE 
Advice to make travel planning easier

• When you make travel plans ask the airline to make contact with their Disability or Special Assistance Co-ordinator. If you need assistance boarding a plane or train, inform personnel when you check in.
  
• When making a hotel reservation, remember to request a ground floor room or handicapped-accessible room, if stairs or walking distances are a problem.
  
• If booking via a travel agent tell them of special needs you have - specific diet, accessible rooms and assistance to change planes. The agent can also advise on safe transport of dialysis supplies while travelling to foreign countries.  
  
• Watch what you eat and drink. Talk to your dietician before you go about what foods to avoid. Don't take the risk of drinking local water - this includes water used for brushing your teeth. Unless you are sure it is absolutely safe, use bottled water. Avoid salads and ice cubes unless you wash the salad or make ice cubes yourself from bottled water. Avoid ice cream and other foods from street vendors.

AUSTRALIAN DIALYSIS UNITS - WHO OFFER TRAVEL ON DIALYSIS PLACES
You must book ahead - there are no guarantees that places will be available

State	Dialysis Unit Location
New South Wales	Away From Home Haemodialysis Program - EnableNSW NSW residents only Eligible haemodialysis patients living in NSW can have access to dialysis services at no cost, when travelling away from home for education, work and holidays. Subject to availability and funding, you can receive up to 3 sessions per year at one of 25 participating private Dialysis Units, away from usual place of residence Patient Fact Sheet. Newcastle: Wansey Dialysis Centre - John Hunter Hospital NSW Call Team Leader in High Dependency on 02 4943 9635 or send request to: Wansey Dialysis Centre, 1A Dudley Road, Charlestown NSW 2290 (FAx 02 4943 9522).
Northern Territory	Alice Springs Dialysis Unit Staff try to keep a shift for travellers with advance notice. Visit the MacDonnell Ranges or Standley Chasm- call this Dialysis Unit on 08 8951 650
Queensland	Cairns Private Hospital Dialysis Unit Subject to availability. Sandy Freeland - call 07 4052 5167 or freelands@ramsayhealth.com.au Townsville Renal Unit  Promotes holiday on dialysis spots - call the dialysis unit on 07 4433 2650
Victoria	Kyabram & District Health Services Holiday dialysis sessions are: Tuesday, Thursday, Saturday in the morning- call Natalie Sheehan on 03 5857 0217. Lorne Dialysis Unit For more information contact Kate Gillan, Director Clinical Services, Lorne Community Hospital, call 03 5289 4307 or email dcs.lorne@swarh.vic.gov.au (brochure soon) Dialysis and Transplant Association D.A.T.A. Members must book ahead to stay at holiday homes in Rosebud, Yarrawonga (ialysis) Blackburn.
Tasmania	Launceston Community Health Centre Renal Unit  22 McHugh Street, Kings Meadows( near Launceston) Tasmania - call 03 6336 5132. Renal Units in this area provide dialysis session to those from North/ North West Tasmania. Vacancy possible for other units with advance notice.
Western Australia	Royal Perth Hospital  Promotes holiday spots - no guarantee.

INTERNATIONAL TRAVEL ON DIALYSIS
Be aware that the quality, standards & charges vary in cities overseas

Bali Indonesia - Nusa Dua
BIMC HOSPITAL Dialysis Unit  
www.bimcbali.com for e-brochure Recent upgrade ensures this Dialysis Unit meets Australian standards. 4 star Hotel nearby. Staff speak: Australian English, German, French, Japanese, Indonesian. 
Australians have dialysed in this facility and reported a top class and luxury treatment. (Oct 2012). 

Jo Skala, Haemodialysis Coordinator  jo@bimcbali.com | dialysiscentre@bimcbali.com 
Email nusadua@bimcbali.com or call +62 361 300 0911 (9-5, 6 days no Sunday. PD patients supported. Charges $399 US per session. Contact dialysis unit before travel for forms to return.

Bulgaria, Croatia, Czech Republic, Egypt, Greece-Crete, Hungary, Italy, Poland, Spain, Tunisia, Turkey
Holiday Dialysis: by Dr Berger  Extensive travel service for dialysis patients.

Canada Travelling Dialysis RV Association Rent an RV with Formula Belco 2000 dialysis machine and WRO95 water purification system - patient must be trained with this type of unit

Canary Islands Club Haemodialysis Fresenius Private Travel info@dialysecanarias.com

Cyprus Dialysis via Cyprus Health Service Promotion Board - Cyprus Holiday Dialysis Unit
Greece - Rhodes  Helionephro Dialysis (approx 250 euros a treatment) Helionephro Sun Dialysis Unit
Greece and other countries Treatment Abroad: Dialysis holidays

Italy - Fresenius in Cemona  Holiday Dialysis International - dialysis cruises online booking/query form

Mauritius  Apollo Bramwell Hospital holiday dialysis - get quote

New Zealand
Kidney Health New Zealand access to holiday Dialysis Units
-   Wellington Region Kidney Society's Taupo Holiday Home (minimum charges apply)
-   Kidney Society of Auckland - Holidays and Travel

Pacific region
-  Fiji Islands Colonial War Memorial Hospital in Suva (east coast - 200 km from west coast holiday spots) Session approx $500 Fiji. Call +679 310 0020 or fijidialysiscentre@gmail.com
-  Western Samoa (Apia) Samoan Kidney Foundation for private holiday dialysis

United Arab Emirates - in Dubai
Zulekha Hospital - Holiday Dialysis Most countries including Australia offered free visa on arrival Travel Visas

United Kingdom
Haemodialysis in Edinburgh Scotland
Dialysis Freedom - dialysis holiday specialists
Private Dialysis UK  Find a holiday/ private dialysis clinic - get quote for anticipated treatment
Renal Assocation of UK - Lists over 70 main Dialysis Units  Sort by map/ postcode

United States of America
Dialysis Units in the USA
Dialysisfinder.com Travel links  Book your dialysis sessions early
NKF (USA) Holiday Pages
Travelling on dialysis advice  DaVita USA - hints for travel on dialysis and more
WhereDialysis.com Find Dialysis Facilities in the USA